Division of Cardiology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA.
Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA.
JACC Cardiovasc Interv. 2024 Oct 28;17(20):2337-2349. doi: 10.1016/j.jcin.2024.09.035.
Bleeding events after arterial transcatheter procedures are associated with increased morbidity and mortality. The frequency and clinical implications of bleeding after mitral transcatheter edge-to-edge repair (M-TEER) have not been well-studied.
The authors sought to explore the association of in-hospital bleeding events after M-TEER with patient outcomes.
Patients undergoing M-TEER who were included in the TVT (Transcatheter Valve Therapy) Registry between 2013 and 2022 were included. Rates of the primary endpoint, the composite of death or hospital readmission at 30 days, were compared between patients who experienced in-hospital major or life-threatening bleeding vs those without bleeding. Secondary analyses examined the association between in-hospital bleeding and death or readmission at 1 year, as well as independent predictors of major in-hospital bleeding.
Over the study period, in-hospital major bleeding occurred in 1,205 (2.3%) of 51,533 patients. Rates of bleeding decreased over time (from 7.1% in 2013 to 2.0% in 2021; P < 0.001). In-hospital bleeding was associated with increased rates of death or readmission at both 30 days (adjusted OR: 2.15 [95% CI: 1.81-2.54]; P < 0.0001) and 1 year (adjusted HR: 1.43 [95% CI: 1.27-1.60]; P < 0.0001). The strongest correlates of in-hospital bleeding included female sex, prior percutaneous coronary intervention, baseline hemoglobin, greater procedure acuity, and longer procedure duration.
Bleeding after M-TEER is associated with increased risk of subsequent death and hospital readmission. Although reductions in bleeding complications over time are encouraging, continued efforts are needed to further mitigate hemorrhagic complications of M-TEER.
经动脉导管介入手术后出血与发病率和死亡率增加有关。经导管二尖瓣缘对缘修复术（M-TEER）后出血的频率和临床意义尚未得到很好的研究。
作者旨在探讨 M-TEER 后住院期间出血事件与患者结局的关系。
纳入 2013 年至 2022 年 TVT（经导管瓣膜治疗）注册研究中接受 M-TEER 的患者。比较发生院内大出血或危及生命的出血患者与无出血患者的主要终点（30 天内死亡或再入院的复合终点）发生率。进一步的次级分析检查了院内出血与 1 年时死亡或再入院的关系，以及院内大出血的独立预测因素。
在研究期间，51533 例患者中有 1205 例（2.3%）发生院内大出血。出血发生率随时间下降（从 2013 年的 7.1%降至 2021 年的 2.0%；P<0.001）。院内出血与 30 天内死亡或再入院（校正比值比：2.15[95%置信区间：1.81-2.54]；P<0.0001）和 1 年时死亡或再入院（校正 HR：1.43[95%置信区间：1.27-1.60]；P<0.0001）发生率增加相关。院内出血的最强相关因素包括女性、既往经皮冠状动脉介入治疗、基线血红蛋白、较高的手术紧迫性和较长的手术时间。
M-TEER 后出血与随后死亡和住院再入院的风险增加相关。尽管出血并发症随时间减少是令人鼓舞的，但仍需要继续努力进一步减少 M-TEER 的出血并发症。
